ReviewIntravenous acetaminophen as an adjunct to multimodal analgesia after total knee and hip arthroplasty: A systematic review and meta-analysis

•To perform a meta-analysis to investigate the impact of acetaminophen for pain management after TJA.•Intravenous acetaminophen to multimodal analgesia could significantly reduce pain after TJA.

BackgroundThis meta-analysis aimed to perform a meta-analysis to investigate the impact of additional intravenous acetaminophen for pain management after total joint arthroplasty (TJA).MethodsWe conducted electronic searches of Medline (1966-2017.07), PubMed (1966-2017.07), Embase (1980-2017.07), ScienceDirect (1985-2017.07) and the Cochrane Library. Randomized controlled trials (RCTs) and non-RCTs were included. The quality assessments were performed according to the Cochrane systematic review method. The primary outcomes were postoperative pain scores and opioid consumption. Meta-analysis was performed using Stata 11.0 software.ResultsA total of four studies were retrieved involving 865 participants. The present meta-analysis indicated that there were significant differences between groups in terms of pain scores at POD 1 (WMD = −0.954, 95% CI: −1.204 to −0.703, P = 0.000), POD 2 (WMD = −1.072, 95% CI: −2.072 to −0.073, P = 0.000), and POD 3 (WMD = −0.883, 95% CI: −1.142 to −0.624, P = 0.000). Significant differences were found regarding opioid consumption at POD 1 (WMD = −3.144, 95% CI: −4.142 to −2.146, P = 0.000), POD 2 (WMD = −5.665, 95% CI: −7.383 to −3.947, P = 0.000), and POD 3 (WMD = −3.563, 95% CI: −6.136 to −0.991, P = 0.007).ConclusionAdditional intravenous acetaminophen to multimodal analgesia could significantly reduce pain and opioid consumption after total joint arthroplasty with fewer adverse effects. Higher quality RCTs are required for further research.